Samuel Joe Justiss, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA06923 Issued in TX

Practice address

4450 Sunset Dr
San Angelo, TX 76901-5611

Phone

(325) 658-1511

Fax

(325) 481-2166

NPI assigned

Oct 22, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shannon ClinicGroup PAC ID 0840103727, 550 clinicians

Dora Roberts Rehabilitation CenterGroup PAC ID 0941285498, 114 clinicians

The West Texas Rehabilitation CenterGroup PAC ID 2860301215, shared by 5 NPIs, 444 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Shannon Medical Center Hospital, San Angelo, TX, CCN 450571
• Ballinger Memorial Hospital Hospital, Ballinger, TX, CCN 451310

Merit-based Incentive Payment System (MIPS)

Final score

82.63 of 100Reported as group

Quality

78.21

Promoting interoperability

96

Improvement activities

40

Cost

67.22

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sjustiss6759@shannonhealth.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shannon Clinic

  • Family Medicine Physician
  • San Angelo, TX
  • NPI 1770587149
  Medicare reassignment Care Compare group NPD
• Dora Roberts Rehabilitation Center

  • Rehabilitation Clinic/Center
  • Big Spring, TX
  • NPI 1760486708
  Care Compare group
• San Angelo Emergency Physicians

  • Emergency Medicine Physician
  • San Angelo, TX
  • NPI 1134177975
  NPD (past)
• Shannon Clinic

  • Pediatrics Physician
  • Del Rio, TX
  • NPI 1790986719
  NPD (past)
• Texas Em-1 Medical Services, PA

  • Physician Assistant
  • Texarkana, TX
  • NPI 1558314062
  NPD (past)
• Texas Emergency Room Services PA

  • Emergency Medicine Physician
  • Del Rio, TX
  • NPI 1447200696
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ballinger Memorial Hospital District

  • Land Ambulance
  • Ballinger, TX
  • NPI 1215991039

  Hospital

  Care Compare affiliation
• Ballinger Memorial Hospital District

  • Critical Access Hospital
  • Ballinger, TX
  • NPI 1225038938
  Care Compare affiliation
• Shannon Medical Center

  • General Acute Care Hospital
  • San Angelo, TX
  • NPI 1992707228
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479686400000",
    "number": "1598065799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 SUNSET DR",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769015611",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUSTISS",
        "first_name": "SAMUEL",
        "middle_name": "JOE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-22",
        "last_updated": "2016-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "838N78",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "219693301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendi Jordan, LPC
• Tyler Adam Jowers
• Rebecca Sue Joy
• Jumano Emergency Physicians
• Jesse L Jurado, M.D.
• Kala Pharmacy Corp
• Kala Pharmacy Corp
• Jocelyn Belen Kaneshi
• Douglas J Kappelmann, MD
• Lisa Ann Karp, NNP-BC

• Physician Assistant in San Angelo, TX
• Providers in San Angelo, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.